Comparison of Two Peripherally Inserted Catheters: a Central Venous and a Midline

In the United States more than 5 million patients each year get a central venous catheter. Indications for central venous catheterization include infusion of irritant drugs like chemotherapy or total parenteral nutrition, poor peripheral venous access and long term administration of drugs such as antibiotics. This ubiquitous procedure has many associated complications that result in morbidity, mortality, and increased healthcare cost. The overall complication rate is more than 15% and a great preventive effort is done.

Catheter Related Bloodstream Infection (CRBSI) is a serious and feared complication associated with prolonged hospital stays, increased costs and risk of mortality. CRBSI is defined as the presence of bacteremia originating from an intravenous catheter. A lot of effort is done to reduce CRBSI including heightened attention to hygiene in placement and care, improved education and training, and placement of a team with specialized skills. Adherence to best practice for central line placement is shown to reduce risk of CRBSI .

Moreover, central venous catheters (CVCs) are associated with deep vein thrombosis (DVT) and pulmonary embolism. Besides interruption in treatment, catheter-related DVT increases morbidity and mortality. Cancer and admission to intensive care are independent risk factors. Existing data report wide estimates of this adverse outcome, ranging from less than 1% to as high as 38.5%, dependent on the population studied, method of diagnosis, and use of prophylaxis measures.

Peripherally inserted central catheter (PICC) is a CVC which placement and use have been widespread since it was first described in 1975. It is a well-established alternative to CVCs placed via subclavian or jugular veins. It is easy to place, safe and cost-effective compared to others often used central lines. PICC is inserted via a peripheral vein in the upper arm and terminates like other central lines in the vena cava superior. Placement and use is associated with few complications .

Another peripherally inserted catheter is the midline which by definition is 7.5 to 20 centimeters long (3-8 inches) and thus not a CVC. The midline catheter was introduced in 1950s. It has undergone major improvement in material technology and techniques for achieving vascular access. It is inserted in the same peripherally veins as the PICC, but the tip is advanced no further than the distal axillary vein and is therefore classified as a peripheral intravenous catheter with corresponding advantages and disadvantages. The midline cannot be used to vesicants or irritants like most chemotherapy, vasoactive agents, or medications with extremely low or high pH values. The midline is suitable for use from 5 days until 4 weeks to drugs and solutions, which safely can be administrated in a peripheral venous catheter. Severe complication to placement and use of midline is rare, but due to previous problems primarily related to the midline catheter material, its use is limited .